- Seldinger technique
The Seldinger technique is a
medical procedureto obtain safe access to blood vessels and other hollow organs. It is named after Dr. Sven-Ivar Seldinger (1921-1998), a Swedish radiologist from Mora, Dalarna County, who introduced the procedure in 1953.cite journal |author=Seldinger SI |title=Catheter replacement of the needle in percutaneous arteriography; a new technique |journal=Acta radiologica |volume=39 |issue=5 |pages=368–76 |year=1953 |pmid=13057644]
The desired vessel or cavity is punctured with a sharp hollow needle called a
trocar, with ultrasound guidance if necessary. A round-tipped guidewireis then advanced through the lumen of the trocar, and the trocar is withdrawn. A " sheath" or blunt cannula can now be passed over the guidewire into the cavity or vessel. Alternatively, drainage tubes are passed over the guidewire (as in chest drains or nephrostomies). After passing a sheath of tube, the guidewire is withdrawn.
If a sheath is used, it can be used to introduce
catheters or other devices to perform endoluminal (inside the hollow organ) procedures, such as angioplasty. Fluoroscopymay be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrastmay be used to visualise organs. Interventional procedures, such as thermoablation, angioplasty, embolisation or biopsy, may be performed.
Upon completion of the desired procedure, the sheath is withdrawn. In certain settings, a sealing device may be used to close the hole made by the procedure.
The Seldinger technique is used for
angiography, insertion of chest drains and central venous catheters, insertion of PEG tubes using the push technique, insertion of the leads for an artificial pacemakeror implantable cardioverter-defibrillator, and numerous other interventional medical procedures.
The initial puncture is with a sharp instrument, and this may lead to
hemorrhageor perforationof the organ in question. Infectionis a possible complication, and hence asepsisis practiced during most Seldinger procedures.
Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication. [cite journal |author=Schummer W, Schummer C, Gaser E, Bartunek R |title=Loss of the guide wire: mishap or blunder? |journal=British journal of anaesthesia |volume=88 |issue=1 |pages=144–6 |year=2002 |pmid=11881872 |url=http://bja.oxfordjournals.org/cgi/content/full/88/1/144 |doi=10.1093/bja/88.1.144]
History and impact
Prior to the description of the Seldinger technique, sharp trocars were used to create lumens through which devices could be passed. This had a high rate of complications.cite journal |author=Higgs ZC, Macafee DA, Braithwaite BD, Maxwell-Armstrong CA |title=The Seldinger technique: 50 years on |journal=Lancet |volume=366 |issue=9494 |pages=1407–9 |year=2005 |pmid=16226619 |doi=10.1016/S0140-6736(05)66878-X] However, with the introduction of the Seldinger technique,
angiographybecame a relatively risk-free procedure, and the field of interventional radiologyblossomed.
Building on the work of Seldinger,
Charles Dotterand Andreas Gruentzigdeveloped angioplasty.
* [http://www.frca.co.uk/article.aspx?articleid=100029 Flash animation of the Seldinger technique] (FRCA.co.uk)
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Look at other dictionaries:
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